Her Space Boxing
Boxing/Fitness Class for Teen Girls aged 13-17 Tuesday and Thursdays 5pm-6pm (45 weeks) MEMBERSHIP FORM MUST BE COMPLETED ALONGSIDE THIS FORM
Name of Child (Participant)
*
First Name
Last Name
Date Of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Childs Ethnicity
*
Please Type
Asian or Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Black, Black British, Caribbean or African
Caribbean
African
Any other Black, Black British, or Caribbean background
Mixed or multiple ethnic groups
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed or multiple ethnic background
White
English, Welsh, Scottish, Northern Irish or British
Irish
Gypsy or Irish Traveller
Roma
Any other White background
Other ethnic group
Arab
Any other ethnic group
Emergency Contact
*
First Name
Last Name
Emergency Contact Email
*
example@example.com
Emergency Contact Number
*
Please enter a valid phone number.
Format: 00000000000.
Do you give permission for photos/videos of your child to be taken?
*
Yes
No
If you answered Yes, do you give permission for us to use them on our social media?
Yes
No
Does the child have any medical conditions, Disabilities seen or unseen? Please list them below.
*
Does the child take any medication?
*
If 'Yes" We advise that you bring any relevant medication along e.g inhaler
Does the child have any experience in fitness or boxing. e.g Gym, Running, Football?
*
Does your child have any interest in competitive boxing?
These sessions will run twice a week. Does your child intend to attend both sessions?
Parent Consent Statement
I consent for my child to participate in boxing fitness, understanding that it is challenging and that safety will be prioritised. I acknowledge that all coaches are DBS checked, and that if my child wishes to take boxing seriously, they can progress to our contact boxing session.
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